Patients will skip care with higher deductibles and copays

The Wall Street Journal reported that overall medical use fell as patients had fewer doctor office visits, lab testing, and maintenance medications possibly due to the recession or as a result of consumer driven healthcare in the way of higher deductibles and copays.

This is very worrisome. Certainly patients should have some financial responsibility for their care, but skimping on care will only result in Americans not becoming healthier, but sicker. Though the article cited some examples of patients saving money by not seeing their allergist for a refill of medication and simply calling for one and getting an athletic physical at a local urgent care clinic for $40 rather than $90 at the doctor’s office, these tiny behavior changes aren’t going to bend the cost curve in medical care.

Sure, some patients are holding off on elective surgeries. This might be a good thing as research has suggested that Americans get too many procedures compared to other industrialized countries. However, this could be equally as bad as there may be an equal number of people who truly need surgery to improve their quality of life and ability to walk but can’t do so because they can’t afford it.

With more financial responsibility of higher deductibles and copays, patients will simply skip care, specifically, needed medical care. As the drugstore CVS noted, there was a “drop-off in new prescriptions for maintenance drugs tied to a decline in physician visits”. In other words, patients are not getting treated for their high cholesterol, high blood pressure, or diabetes to prevent premature heart attacks or strokes.

Paul Ginsburg, a respected health economist of the Center for Studying Health System Change noted that this patient behavior “could go beyond the recession. Being a less aggressive consumer of health care is here to stay.”

I disagree with him in the sense that patients weren’t necessarily aggressive before, but behaved in a rational manner when copays were low, there were no costs to medications, lab work, and office visits. The question is with very high financial barriers to seek care will they make the right choices? Will Americans change their behavior and become healthier?

The answer is no.

As a practicing primary care doctor I know when I must seek medical care and when I can safely skip. If this data holds true for the next few years, America will have a very big problem. We will have a less healthy workforce because they cut corners on their health. A generation of Americans who will skip important preventive screening tests because they feel fine and aren’t willing to pay the high copays. Those with medical conditions like diabetes will develop avoidable complications of blindness, kidney failure, and amputations because patients don’t renew their maintenance medications.

Americans will die sooner, have a worse quality of life, and more preventable complications as a result of consumer driven healthcare. The doctors who are best in advising patients on the right care, the primary care doctors like internists and family doctors, are leaving their practice in droves because of issues of work-life balance and decreasing reimbursement. Healthcare costs for the short-term may fall only to rise rapidly as patients are forced to be treated for conditions that could have been handled earlier more easily and for a lot less.

In other words, the perfect storm of a worsening healthcare system is upon us soon.

Which will leave the government no choice but to establish a single payer government run system.